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Semin Plast Surg 2011; 25(1): 034-042
DOI: 10.1055/s-0031-1275169
© Thieme Medical Publishers

Stabilization of the Chest Wall: Autologous and Alloplastic Reconstructions

Raman Chaos Mahabir1 , Charles E. Butler2
  • 1Division of Plastic Surgery, Department of Surgery, Scott and White/Texas A&M University, Temple, Texas
  • 2Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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Publication History

Publication Date:
05 April 2011 (online)

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ABSTRACT

The goals of chest wall stabilization include maintenance of a rigid airtight cavity, protection of the thoracic and abdominal contents, optimization of respiration, and, whenever possible, an aesthetic reconstruction. Evidence suggests that bony fixation results in reduced ventilator dependence, a shorter overall hospital stay, and improved upper extremity function. We prefer to accomplish this with autologous tissue alone (such as the pectoralis major, latissimus dorsi, or rectus abdominus muscle flaps) for small to moderate defects. En bloc resection of defects larger than 5 cm or containing four or more ribs will likely benefit from chest wall stabilization. For patients previously treated with radiation, even larger defects may be tolerated owing to fibrosis. For these larger defects, methyl methacrylate composite meshes are used and covered with vascularized tissue. Contaminated wounds are generally reconstructed with bioprosthetic mesh rather than synthetic mesh. Using these principles, the reconstructive plastic surgeon can devise a comprehensive and safe plan to repair tremendous defects of the chest wall.

KEYWORDS

Chest wall - reconstruction - stabilization - autologous - alloplastic

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Raman Chaos MahabirM.D. 

Associate Professor and Chief of Microsurgery, Division of Plastic Surgery, Department of Surgery, Scott and White/Texas A&M University

2401 South 31st Street, Temple, TX 76508

Email: rmahabir@swmail.sw.org